Schizophrenia, bipolar mood disorder (BMD) and major depressive disorder (MDD) are serious and persistent mental disorders that cause significant impairments and place a heavy burden on caregivers and families (1–5). To provide evidence-based mental health care, caregivers must be skilled, have evidence-based knowledge, monitor patients continuously, and take a holistic approach and despite recent global commitments, countries have performed poorly, inefficiently, and fragmentedly in managing chronic mental illnesses despite the many serious problems they face and the burden they impose on their families, economies, and societies (1, 6). In order to assist patients with special needs, family-centered collaborative care (FCCC) can benefit patients, families, healthcare providers (HCPs), and service providers (7, 8). A critical component of FCCC is the involvement of the family as an expert and partner in all care systems. Care and services must be enhanced in the health system to achieve positive patient and organizational outcomes. By providing performance support, reducing unnecessary interventions, increasing knowledge and skills, establishing leadership roles for HCPs, and enhancing competence, the quality of care can be improved by clinical practice guidelines (CPGs) (9, 10). CPGs can assist caregivers and HCPs in developing and implementing evidence-based interventions. As well as identifying gaps in the evidence base, these tools can guide future research. A systematic review of guidelines recommending FCCC was conducted by the research team despite evidence suggesting that CPGs improve clinical practice, questions remain regarding guideline development and quality (11–13). The best available evidence should be used to inform the development of published guidelines (13, 14). Concerns about the quality of CPGs may arise because guideline committees may be biased, which has an impact on the recommendations they make (15). In addition, recommendations on one topic from different organizations also vary (16, 17). As a result, guidelines need to be developed and submitted in a consistent and rigorous manner despite recommendations for the appropriate methodology (17–19), an earlier study assessing the quality of CPGs between 1985 and 1997 found that the guidelines did not meet established methodological standards (20). The development of guidelines is also of considerable importance with respect to conflict of interest reporting (21). CPGs play a significant role in health care, and making their development process more transparent would help to reduce conflicts of interest. As part of a recent agreement on guideline development, the council demanded that members of the guideline development group disclose conflicts of interest, but failed to include this information within the guideline (22).

It is important to ensure that the method of developing guidelines is free of biases, that recommendations are internally and externally valid, and that recommendations are clinically relevant (23). Increasing complexity, heterogeneity, and number of clinical guidelines has led to the need for internationally recognized standards for assessing clinical guidelines' quality (24, 25).

Despite the fact that CPGs are increasingly being used to treat patients with severe and persistent mental disorders, since their quality is unstable, there have been concerns regarding their reliability, which has implications for methodological evaluation, and can adversely affect the usefulness and benefits of guidelines (25–27). Conflict of interests are also important elements of AGREE II (Appraisal of guidelines for research and evaluation), a validated questionnaire used to evaluate CPG's methodological quality (22). A systematic review of additional assessment tools utilized to assess CPGs discovered AGREE had the most potential to function as guidelines critical appraisal tools (28). The use of the AGREE II instrument is nowadays general in published scientific analyses and it has also been adopted by major health bodies in their evaluation of CPGs (29).

Thus, this analysis aimed to evaluate the quality of CPGs for the FCCC of individuals with schizophrenia, BMD, and MDD published over the last 13 years by utilizing AGREE II instrument to clinically involve them with patients to improve evidence-based judgments and enhance the safety of the patients and the HCPs.

This study presents the first critical appraisal of guidelines with recommendations related to FCCC for individuals with chronic mental illnesses like schizophrenia, MDD, or BMD to our knowledge. It was found that 16 sets of guidelines published between 2009 and 2021 included at least one specific FCCC recommendation aimed at individuals after diagnosis of chronic mental illness.

These results demonstrate the need for better-developed guidelines addressing FCCC in populations with chronic mental illness. In addition, most guidelines focused on mental illnesses such as symptom management rather than specifically family or collaboration. The majority of guidelines were relevant to patients at the beginning of the severe mental illness care continuum, which demonstrates the need for customized FCCC guidelines and how HCPs can involve informal caregivers in their care. This study highlights, however, the need for further research on FCCC's role in managing chronic mental illnesses such as schizophrenia, MDD, and BMD. Despite the large differences in quality between the guidelines, stakeholders identified a few guidelines of acceptable quality for targeting FCCC recommendations for chronic mental illness populations.

For overall quality assessment, six guidelines met the quality threshold with domain scores of >60%. Stakeholders can use these findings to develop guidelines for clinical and research practice that are well-developed and suggestive. These guidelines were strongest in terms of scope and purpose, as well as clarity of presentation. Applicability received lower quality scores. Based on our search, no research has been done that has examined clinical guidelines with recommendations related to FCCC of patients with chronic mental disorders using the AGREE II tool.

An evaluation of the Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines was conducted in 2022 by Hans te Brake and his colleagues using AGREE-HS, a quality assessment tool with five core quality items focusing on (1) topic; (2) participants; (3) methods; (4) recommendations; and (5) implementation (52, 53) while we used the version of AGREE II that was updated on December 2018 to evaluate the guidelines. Among most included guidelines, FCCC recommendations for HCPs need considerable improvement regarding their applicability and implementation in practice. There are knowledge gaps associated with identifying the involvement of informal caregivers in the care of individuals with Schizophrenia, BMD, and MDD when applying FCCC recommendations.

Guidelines with a score of >60% in five or more areas in the quality report present strategies for implementing recommendations, such as family engagement training programs for HCPs (30, 32, 33, 35, 39, 41, 44). Relevant information on personalized care, such as psychological interventions, carers in care planning, assessing physical health, medications, supported employment programs, preventing violence and aggression, practice and educational recommendations about assessment of adults at risk for suicidal ideation and behavior and care plan, psychosis, treatment across all phases, substance misuse and primary care, psycho-education, and community treatment was also provided in several guidelines.

To facilitate the application of these guidelines to clinical practice, additional research is needed to determine practical knowledge translation techniques. Quality scores >60% were found for scope and purposes, Stakeholder involvement, the rigor of development, clarity of presentation, and editorial independence. It was found that several guidelines were lacking adequate information on the literature search methods and article selection criteria, how the evidence was described and graded, sufficiently as the exact process for developing recommendations.

In our analysis, several guidelines did not report on external reviews. Individuals with a research or clinical expertise in the area or those who benefit from using relevant guidelines can evaluate these recommendations thoroughly, comprehensively, and unbiasedly. The process for updating evidence-based guidelines is another important consideration. For example Crawford et al., which is included in this review, published an update to the 2021 survivorship guidelines in 2011 (33). For target users to be aware of current evidence-based best practices, it is essential to examine and revise recommendations occasionally due to the quick emergence of further evidence in this evolving domain of research (54, 55).

A key strategy to improve the rigor of guideline development in research is to use reproducible and systematic literature searches, provide adequate details about how recommendations were developed and modified, receive feedback from external reviewers, and update the guidelines regularly. The guidelines reviewed in this review included a range of practices regarding stakeholder involvement. A wide range of professions and expertise areas were represented on most guideline development teams. Despite the majority of selected guidelines incorporating findings on the care of individuals with Schizophrenia, BMD, and MDD, few recommendations directly addressed the way in which families should be involved in the care process. For the guideline development for the target population, it is important to explore and incorporate the views and preferences of people with Schizophrenia, BMD, and MDD, their informal caregivers, and HCPs. Thus, recommendations can be confirmed as applicable to the target population. Stakeholders should be involved at least within the external review process of guideline development, despite the benefits of integrating them throughout the process.

There were extensive reports on funding sources among the members of previous guidelines on editorial independence. Although specific conflicts of interest are not always addressed adequately, they can have an impact on the development and content of guidelines. Family involvement in mental illness research may present fewer conflicts of interest than in other fields, but they should still be documented as part of classic practices in guideline development. The clarity of presentation for the recommendations was practical in considerable guidelines reviewed.

An especially significant example of guidelines for individuals with Schizophrenia, BMD, and MDD where the FCCC recommendations and other suitable knowledge were efficiently identifiable and given by the NICE (2020) (32). This aspect is important for caregivers, patients, and actually, HCPs who may not have enough knowledge, time, or skills to search via lengthy, complex records for relevant knowledgeAn area of strength in the guidelines included in this review was the detailed overview of the purpose and scope of the recommendations. Most guidelines specified their objectives and health questions, by determining the general population, intervention, and outcomes under study. This knowledge would be beneficial in providing the correct application of the recommendations according to particular patient characteristics.

Limitations of our review contain possible selection bias in inclusion criteria. Guidelines that did not have recommendations on exact FCCC parameters were excluded. For example, 25 guidelines about managing mental disorders suggested, but did not include precise recommendations about FCCC and were unrelated to the PIPOH model of the study were excluded as these did not meet the criteria for our definition of FCCC, and including these was beyond the scope of this study's purposes and search strategy. Furthermore, guidelines that were not published in the English language were excluded. Regardless, this review helps to identify acceptable quality records within a set of newly disseminated guidelines that contain FCCC recommendations for people with Schizophrenia, BMD, and MDD. Further limitations are connected with the use of the AGREE II tool for the critical appraisal of the guidelines contained in this review. The mid-scores of the 7-point scale on the AGREE II tool have not been well defined for each object. There are no exact recommendations on solving domain and overall quality scores or setting precise cut-off scores to distinguish quality guidelines. Although based on earlier guideline evaluations, the use of the 60% cut-off score is somewhat incidental (46, 48). However, this tool allows an exhaustive assessment of guidelines and should be consulted in the development of prospective recommendations. Eventually, these results emphasize the necessity for further research utilizing rugged methods and examining FCCC, particularly in other chronic mental illnesses.

Most of the guidelines designed newly include FCCC recommendations for individuals diagnosed with mental illness. These guidelines involve schizophrenia, MDD, and BMD and cover different broad topics (e.g., medication, care, treatment, etc.). According to AGREE II criteria, the stability of existing guidelines contains the title of scope and purpose, as well as the clarity of presentation. Improvement is needed in the applicability of guidelines. Also, there are limitations in the primary study reporting the recommendations, and guidelines of sufficient quality exist to stakeholders on FCCC for the people with Schizophrenia, BMD, and MDD. HCPs and informal caregivers can play an important function in helping these patients throughout the illness continuum and help from permit to well-developed and suitable care to solve research understanding on effective rehabilitation strategies, including FCCC.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

Conceptualization and data collection: RD and MF-M. Data analysis: RD, MS, and EM-S. Funding acquisition: MF-M. Methodology and writing—review and editing: RD, MF-M, and MS. Project administration and supervision: MF-M and MS. Validation: EM-S, MS, and MF-M. Writing—original draft: RD. All authors contributed to the article and approved the submitted version.